Bronchodilators and Corticosteroids in the Treatment of Obstructive Pulmonary Emphysema

Franklin, William; Michelson, Alan L.; Lowell, Francis C.; Schiller, Irving W.

doi:10.1056/nejm195804172581602

Cited by 39 publications

(8 citation statements)

References 5 publications

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“…This is in keeping with the findings of Franklin et al (1958). Kennedy (1961), Gregg (1969), and Lukas (1951) similarly showed potentiation in some patients although they did not discuss this particular finding.…”

Section: Resultssupporting

confidence: 81%

“…Kennedy (1961) published records of a series of asthmatic patients, three of whom showed a clear increase in their response to isoprenaline when they were on corticosteroids. Franklin et al (1958) studied 58 patients with 'obstructive pulmonary emphysema' and found that, in general, the increase in vital capacity after inhaled isoprenaline was greater when the patients were on corticosteroids. However, not all their patients showed this pattern of response.…”

mentioning

confidence: 99%

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Interaction of corticosteroids and catecholamines in the treatment of asthma.

Shenfield¹,

Hodson²,

Clarke³

et al. 1975

Thorax

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Section: Resultssupporting

confidence: 81%

mentioning

confidence: 99%

Interaction of corticosteroids and catecholamines in the treatment of asthma.

Shenfield¹,

Hodson²,

Clarke³

et al. 1975

Thorax

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“…They have not previously been used in patients with 'irreversible' airways obstruction associated with chronic bronchitis, although a short report on the use of triamcinolone acetonide aerosol has indicated that some will respond to this route of corticosteroid administration (Matlin, 1976). Oral corticosteroids, however, have been used in several studies with some investigations claiming objective improvement (Franklin et al, 1958;Clifton and Stuart-Harris, 1962;Beerel et al, 1963;Freedman, 1963), some, subjective improvement only (Cullen and Reidt, 1960;Beerel and Vance, 1971), and others no benefit (Morgan and Rusche, 1964;Oppenheimer et al, 1968;Evans et al, 1974).…”

mentioning

confidence: 99%

A comparison of oral and inhaled steroids in patients with chronic airways obstruction: features determining response.

Harding¹,

Freedman²

1978

Thorax

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Harding, S. M., and Freedman, S. (1978). Thorax, 33,[214][215][216][217][218]. A comparison of oral and inhaled steroids in patients with chronic airways obstruction: features determining response. Two trials comparing aerosol and oral steroid treatment were carried out in patients with chronic airways obstruction. All patients had a history of chronic productive cough and an FEV1 less than 70% predicted but did not have episodic or seasonal breathlessness with wheezing. One trial involved 18 outpatients, the other 18 inpatients. Both studies involved three consecutive treatment periods, the first with placebo aerosol, the second with active aerosol (betamethasone valerate, 800 ug/day), and the third with oral prednisone or prednisolone (30 mg/day). Six patients showed a significant improvement in ventilatory capacity on steroids. Initial assessment included a comprehensive history using a questionnaire, skin tests, blood and sputum eosinophil counts, and chest radiography. In addition, for the inpatients, response to isoprenaline, daily sputum volume, and Paco2 were measured. Only blood eosinophilia and variability in ventilatory capacity during the placebo period seemed indicative of a likely response to steroids. However, there was a large overlap between various features on assessment in the responders and non-responders, and the management of every patient with chronic airways obstruction should include a controlled trial of steroids. The steroid aerosol produced a good improvement in ventilatory capacity in the responsive patients who were hospitalised and this was thought to be helped by supervision of aerosol technique. Such an aerosol could therefore be used for a steroid trial although oral steroids were found to give a more definitive response.

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“…Previous studies of the effect of prednisone in chronic airways obstruction have given variable, and generally discouraging, results. Earlier studies (Franklin, Michelson, Lowell, and Schiller, 1958;Corazza, Morrow, and Chesney, 1961;Clifton and Stuart-Harris, 1962;Freedman, 1963;Fuleihan, Feisal, and Malouf, 1967) were not controlled. Moyes and Kershaw (1957) concluded that there was no significant symptomatic benefit to chronic bronchitics given tetracycline plus prednisone, 15 mg/day, as opposed to tetracycline alone.…”

Section: Resultsmentioning

confidence: 94%